Cellular Pleomorphic Adenoma in the Salivary Gland: Diagnostic and Therapeutic Approaches

Background and Objectives Cellular pleomorphic adenoma (PA) is a histological subtype of PA characterized by a predominance of epithelial and/or myoepithelial cells with minimal stromal components. This cellularity complicates preoperative differentiation from malignant salivary gland tumors. The present study aimed to evaluate the clinicopathological features of cellular PA and propose optimal diagnostic and therapeutic strategies. Subjects and Method We conducted a retrospective review of 31 cases of cellular PA diagnosed between 2000 and 2024 at a single tertiary institution. Inclusion criteria required surgical pathology reports confirming cellular PA. Clinical characteristics, diagnostic methods, surgical approaches, and outcomes were analyzed. Detailed histopathological review was performed in 18 cases. Results Among 31 patients (22 females, 9 males; mean age, 56 years), 80.6% of tumors were located in the parotid gland. In the reviewed specimens, 94.4% (17 of 18) demonstrated >70% tumor cell density. All tumors were well-circumscribed without invasion, cytologic atypia, or frequent mitosis. Fine needle aspiration yielded low diagnostic accuracy (40%), and core needle biopsy was similarly limited. Imaging studies suggested benign features in only 55% of cases. Surgical excision was performed in all cases, with negative margins in 74.2%. Recurrence was observed in 3 cases (9.7%) during the long-term follow-up (69.5-223.1 months). Conclusion Cellular PA presents a diagnostic challenge due to its high cellularity and lack of stromal components, often mimicking malignancy in preoperative evaluations. Given its diagnostic ambiguity, complete surgical resection with an adequate margin is recommended to ensure definitive diagnosis and minimize recurrence.